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The study included patients with low-, intermediate-, and high-risk tumors with 67% of the patients with a tumor size no larger than 2 cm, 57% of the patients with node-negative disease, and an anticipated relatively low number of HER2-positive and/or HER2-enriched patients (all having 10%-100% estrogen receptor expression) ([3]). The strengths of our study include the treatment of breast cancer patients according to national guidelines ([5]). We thank Pederson and colleagues ([1]) and Chlebowski and colleagues ([2]) for their thoughtful correspondence related to our study. [Extracted from the article]

Safety of pregnancy in women with history of estrogen receptor (ER)-positive breast cancer remains controversial. In this multicenter case-control study, 333 patients with pregnancy after breast cancer were matched (1:3) to 874 nonpregnant patients of similar characteristics, adjusting for guaranteed time bias. Survival estimates were calculated using the Kaplan-Meier analysis; groups were compared with the log-rank test. All reported P values were two-sided. At a median follow-up of 7.2 years after pregnancy, no difference in disease-free survival was observed between pregnant and nonpregnant patients with ER-positive (hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.70 to 1.26, P = .68) or ER-negative (HR = 0.75, 95% CI = 0.53 to 1.06, P = .10) disease. No overall survival (OS) difference was observed in ER-positive patients (HR = 0.84, 95% CI = 0.60 to 1.18, P = .32); ER-negative patients in the pregnant cohort had better OS (HR = 0.57, 95% CI = 0.36 to 0.90, P = .01). Abortion, time to pregnancy, breastfeeding, and type of adjuvant therapy had no impact on patients' outcomes. This study provides reassuring evidence on the long-term safety of pregnancy in breast cancer survivors, including those with ER-positive disease. [ABSTRACT FROM AUTHOR]

Background Indications for adjuvant endocrine treatment of breast cancer have gradually increased over the past several years. We aimed to define subgroups of patients who may or may not benefit from adjuvant endocrine therapy. Methods A population-based cohort of systemically untreated breast cancer patients (N = 3197) were identified within the registry of the Danish Breast Cancer Cooperative Group (DBCG). The patients were node negative and had estrogen receptor–positive and/or progesterone receptor–positive tumors (except medullary tumors) and were further characterized by the following risk factors: aged 35–74 years (grouped into 5-year categories) at surgery, tumor size (≤20 mm), and histopathology (grade 1 ductal carcinoma, grade 1 or 2 invasive lobular carcinoma, other or unknown histopathology). Standardized mortality ratios (SMRs) were calculated based on the mortality rate (observed number of deaths per 100 000 person-years) among patients relative to the mortality rate in the general population of women (expected number of deaths per 100 000 person-years). The association between standardized mortality ratio and risk factors were analyzed in univariate and multivariable Poisson regression models. All findings were validated in a subsequent DBCG cohort of breast cancer patients (N = 2710). Results The median follow-up after surgery was 14.8 years. In the study population there were 970 deaths compared with expected death of 737 women, which was an excess mortality of 233 deaths (SMR = 1.32, 95% CI = 1.24 to 1.40). Mortality rates were 2356 per 100 000 person-years in the study population and 1790 per 100 000 person-years in the general population of women. The mortality rate was associated with larger tumor size (11–20 mm tumors vs 1–10 mm tumors, SMR = 1.42, 95% confidence interval [CI] = 1.31 to 1.53 vs SMR = 1.12, 95% CI = 1.00 to 1.26). The mortality rate was also associated with age (35–59 years, SMR > 1) compared with that in the general population of age-matched women, except for a small subgroup of patients (aged 60–74 years, tumors ≤10 mm, grade 1 ductal carcinoma, and grade 1 or 2 lobular carcinoma: adjusted relative risk = 1.02, 95% CI = 0.89 to 1.16.). Conclusions A small subgroup of breast cancer patients who were 60 years or older and had hormone-responsive early-stage tumors up to 10 mm, and received no systemic adjuvant therapy, were not at increased risk of mortality compared with women in this age-group in the general population. [ABSTRACT FROM PUBLISHER]

The authors respond to a commentary on their article "Population-Based Study of Peritumoral Lymphovascular Invasion and Outcome Among Patients With Operable Breast Cancer." They claimed that the data presented by Debled et al. served as a confirmation of their findings but they expressed reservations about the additional evidence which may be derived from the data from Debled et al. They also agreed on the necessity of quality control, external review and the use of technologically advanced methods in the study.